Alberta (AB)
Alberta Health Care Insurance Plan:
Financing

Monthly Premiums

The following premiums are payable monthly through a group plan, or quarterly if paid direct:

Basic Rates (effective July 1/95)

Single Coverage

• $34.00 (regular premiums) over $7,560 adjusted taxable balance
• $27.20 (20% subsidy) 6,921 - 7,560 adjusted taxable balance
• $20.40 (40% subsidy) 6,281 - 6,920 adjusted taxable balance
• $13.60 (60% subsidy) 5,641 - 6,281 adjusted taxable balance
• $6.80 (80% subsidy) 5,001 - 5,640 adjusted taxable balance
• $0.00 (full subsidy) under 5,000 adjusted taxable balance

Family Coverage (2 or more people)

• $68.00 regular premiums over $12,620 adjusted taxable balance
• $54.40 (20% subsidy) 11,341 - 12,620 adjusted taxable balance
• $40.80 (40% subsidy) 10,061 - 11,340 adjusted taxable balance
• $27.20 (60% subsidy) $8,781 - 10,060 adjusted taxable balance
• $13.60 (80% subsidy) $7,051 - $8,780 adjusted taxable balance
• $0.00 (full subsidy) under $7,500 adjusted taxable balance

Optional Service Rates (Alberta Blue Cross) effective July 1, l994

Available to all Alberta residents under 65 and to those not eligible to receive the Alberta Widows' Pension

Single Coverage

$20.50 (regular premiums) over $7,560 adjusted taxable balance

$14.35 (subsidized premiums) under 7,560 adjusted taxable balance

Family Coverage

$41.00 (regular premiums) over $12,620 adjusted taxable balance

$28.70 (subsidized premiums) under 12,620 adjusted taxable balance

Utilization Fees

Nursing Homes, Auxiliary Hospital and Mental Health Hospital Charges:

• $24.75 daily for standard ward accommodation
• $26.25 daily for semi-private accommodation
• $28.60 daily for private accommodation

Extra Billing

• extra billing by physicians is prohibited

Billing and Payment

• claims must be submitted to the Commission within 6 months of service to be eligible for payment
• claims for benefits may be submitted by the practitioner or by the resident
• rate of benefits paid for services are prescribed by Commission By-laws

Private Insurance

Same as That Provided by the Provincial Plan

• not allowed except for residents that have elected to opt out of the provincial plan, however, coverage for them cannot include standard ward hospital coverage
• "Optional Health Services' available through Alberta Blue Cross may be insured privately

Over and Above That Provided by the Provincial Plan

Private insurers may provide coverage for all or any part of the following services:

Hospital: anything over standard ward accommodation

Physicians: no private insurance permitted

Lab and X-rays: if the cost is not paid by the plan

Ambulance: entire costs other than between hospitals located in the same city in Alberta

Optometrists: except for any physician's services covered under the provincial plan

Chiropractor: any charge made after the benefit period maximum has been reached

Osteopath: if the service is not covered by the plan

Podiatrist: any charge made after the benefit period maximum has been reached

Physiotherapist: if the cost is not paid by the plan

Nursing Care: if the cost is not paid by the plan

Nursing Homes: if the cost is not paid by the plan

Chronic Care: no private insurance permitted

Out of Province/Country: the differential between the charge and the amount paid by the Provincial Plan

Dental (out of hospital): if the cost is not paid by the plan

Drugs: if the cost is not paid by the plan

Third Party Liability

A resident has no cause of action against a wrong doer for recovery of any injury related expenses covered by the provincial plan.

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